Achilles tendonitis & rupture Flashcards
What is special about the Achilles’ tendon compared to other tendons?
It is the thickest and strongest tendon in the body
What is tendinopathy?
Impaired tendon healing which is a combination of pain, swelling and impaired performance of the tendon
What are the common sites for tendinopathy in general?
- Rotator cuff - supraspinatus tendon
- Wrist extensors - lateral epicondyle
- Wrist pronators - medial epicondyle
- Patellar
- Quadriceps
- Achilles’
What are the most common sites of tendinopathy in athletes vs general population?
Athletes - Achilles’ and patellar
General - Achilles’ and lateral epicondyle
What are the signs/symptoms of tendinopathy?
- Well-localised tenderness
- Insidious onset
- Pain during activity - may resolve after warm up
- Tendon thickening
- Tendon nodularity
- Crepitus - in acute phase of Achilles; tendinopathy
Which medication increases risk of tendinopathy?
Fluoroquinolones e.g. ciprofloxacin - Achilles’ most affected but shoulder and hand can also be affected
What are the risk factors for tendinopathy?
- Athletic training
- Unsuitable equipment e.g. worn-out shoes
- Hard and high-friction playing surface
- Older age
What is shown?
Medial and lateral pressure applied anterior and superior to the Achilles’ insertion elicits pain
“What causes tendinitis?”
Mainly repetitive mechanical loading on the tendons but risk increases with age, genetics, body weight, metabolism and in individuals prone to pro-inflammatory states (e.g. T2DM).
There is disruption of collagen within the tendons, problems with its healing and blood supply which can all contribute to pain.
How common is Achilles’ tendinopathy?
10% of runners
Where is the pain in Achilles’ tendinitis? What elicits the pain?
2-6cm above insertion of tendon into the calcaneus in the avascular zone
Elicited by resisted plantar flexion and passive dorsiflexion of the ankle
What special test is used to check for Achilles’ rupture?
Thompson test: with the patient prone (face down), calf muscles are squeezed, which should intrinsically plantar flex the foot if the Achilles’ is intact.
Which two areas does Achilles’ tendonitis occur?
Mid portion
Interstional
How do you diagnose Achilles’ tendinopathy? What other tests can be done?
Clinical diagnosis
US, MRI and XR (rarley useful unless calcified) can also be done.
What are some differentials for Achilles’ tendonitis?
- Bursitis - retrocalcaeneal
- Pain of other tendons around the Achilles’ tendon - e.g. plantaris
- Fractures calcaneus
- Tear of fasica
- Impingement of the posterior ankle
- Dislocation of peroneal/plantar flexor tendons
- Nerve pain - irritation or neuroma of sural nerve
- Fat pad irritation
- Haglund’s deformity
- Systemic inflammatory disease
Which muscle fibres is the Achilles tendon composed of?
Soleus and gastrocnemius
What is the management of Achilles tendon rupture?
Same day assessment by an orthopaedic specialist
What is the stepwise management of Achilles’ tendonitis?
- Recognise contributing factors and reduce these e.g. fluoroquinolones
- Use cold packs or ice after acute injury
- Simple analgesia for pain relief
- Rest
- If no improvement after 7-10 days –> refer to physiotherapy
- If no response –> refer to sports physician or orthopaedics
- Exercise programme
- ESWT - extracorporeal shock-wae therapy
- Surgery e.g. debridement or removal of diseased tendon
What triad is used to exclude Achilles’ tendon rupture?
Simmonds triad - patient lies prone
- Angle of declincation - greater dorsiflexion of injured ankle
- Palpation - gap in the tendon
- Calf squeeze test - foot remains in neutral position when calf is sqeezed
USS is the modality of choice for diagnosis.
What are the symptoms of Achille’s tendon rupture?
- Audible snap
- Feeling of being kicked or hit by raquet
- Aching, swelling, mild bruising of the calf
- Difficulty weight bearing
What is shown?
Haglund’s deformity
